Cholesterol of the Blood of Diabetic Children

Abstract

of cholesterol in the blood is today J an exceptional finding in diabetic children in whom the disease is uncomplicated. In eighty per cent, of one hundred such children treated between the years 1926 and 1929, the most recent cholesterol of the blood was below 230 milligrams.Despite this infrequent occurrence, the investigation of fat metabolism and the effects of faulty fat metabolism upon the young organ-CHART 1.Cholesterol, Lecithin and Fatty Acids in the Plasma of 61 Diabetic Children (in nigs, per 100 c.c. blood).ism are of great importance : first, acute fat imbalance occurs more frequently in the child due to his greater susceptibility to coma; second, even among children clinical manifestations of abnormal fat metamorphosis, such as xanthoma diabeticorum, occur; third, in the untreated and pre-insulin treated diabetic child disturbance of lipoid metabolism, manifested by atheromatous degeneration of the vessel walls and lipoid deposition in the reticuloendothelial system, has been the outstanding pathological change found 3,t autopsy1 ; fourth, the child provides the most conclusive material, because of the absence of age factors, for the solution of the etiological significance of faulty fat metabolism as a precursor of arteriosclerosis.Our study of the metabolism of fat in diabetes *From the Clinic of Dr. Elliott P. Joslin and the Laboratory of the New England Deaconess Hospital. \s=d\White\p=m-\Associate Staff, New England Deaconess Hospital. Hunt\p=m-\Director of the Chemical Laboratory at the New England Deaconess Hospital. For records and addresses of authors see "This Week's Issue," page 646.covers four years and includes one hundred and ten children. Undoubtedly a decade or more of time would be preferable to four years, but this interval represents a considerable advance over that of previous series and furnishes what we regard as new links in a chain of evidence rather than ultimate conclusions. The series may be divided into three groups. In the first group are one hundred patients who at the time of observation had no obvious disturbance of fat metabolism ; in the second group are ten patients in whom the analyses were made during coma or severe acidosis ; in the third group are two patients who were studied because of the appearance of xanthoma diabeticorum.Cholesterol, in this work, has been taken as the index of total lipid. In a recent article published by one of us,2 cholesterol has been shown to be the true index of fat metabolism in insulintreated diabetics. This is even more strikingly illustrated in the child than in the adult, as shown in Chart I. Complete fat partitions including cholesterol, lecithin and fatty acids weie done on sixty-one children.As the cholesterol increases there is a strikingly parallel increase in the amount of lecithin and fatty acids. It will be noted that the fatty acid is never below 200 mgs. per cent, when the cholesterol is below 200 and in 94 per cent, of . the cases in which the cholesterol is at this level the fatty acid is above 300 mgs. per cent. A ...

Serum Lipoids in Diabetes

“…Also the fatty acids may be within the normal range when the cholesterolemia is below normal, although normal cholesterol has not been found with subnormal fatty acids. The independence of variations in cholesterol and fatty acids has already been discussed in a previous article on diabetic acidosis (40) and is in contrast to the findings of certain other investigators (7,9,15,27,46,47,59).…”

“…The tendency to obesity of the nine subjects with slightly elevated cholesterols must be considered as peculiar to the individual rather than as the result of a large fat intake. It seems probable that these cholesterols between 250 and 304 milligrams per cent are more closely related to the sex and body build (22,51,59) than to the diabetic condition. Bruger and Poindexter, while studying cholesterolemia in relation to 94 patients who were more than twenty per cent overweight, had in their series only 4 males, but 90 females (.12).…”

The Blood Lipids of Diabetic Children 1

“…In the present investigation, therefore, a study has been made of all blood lipid constituents, namely, total fatty acids, phospholipids, and free and esterified cholesterol, in diabetic children under controlled conditions. Although lipids in the blood of diabetic children have previously been reported (1,2,3), these studies are few in number. Some of them have employed unsatisfactory methods or have dealt with a single lipid constituent, i.e., total cholesterol, which a number of workers regard as an index of the level of other lipid constituents in the blood.…”